title: [Preoperative cardiac-risk assessment for non-cardiac surgery: The French RICARDO survey].
abstract: OBJECTIVE
  Professional practice evaluation of anaesthesiologist for high cardiac-risk patient cares in non-cardiac surgery, and assess disparities between results and recommendations.
  
  
  METHODS
  Since June to September 2011, a self-questionnaire was sent to 5000 anesthesiologist. They were considered to be representative of national anesthesiology practitioner. Different items investigated concerned: demography, preoperative cardiac-risk assessment, modalities of specialized cardiologic advice, per- and postoperative care, and finally knowledge of current recommendations.
  
  
  RESULTS
  We collected 1255 questionnaire, that is to say 25% of answers. Men were 73%, 38% were employed by public hospital; 70% worked in a shared operating theatre with a general activity. With regards to preoperative assessment, 85% of anaesthetists referred high cardiac-risk patient to a cardiologist. In only 16% of answer, Lee's score appeared in anaesthesia file to assess perioperative cardiac-risk. Only 61% considered the six necessary items to optimal estimate of cardiac-risk. On the other hand, 91% measured routinely the exercise capacities by interrogation. The most frequently doing exam (49% of anaesthetist) was an electrocardiogram in elderly patient. In 96% of case, beta-blockers were given in premedication if they were usually thought. Clopidogrel was stopped by 62% of anesthetist before surgery. In this case, 38% used another medication to take over from this one. Only 7% considered revascularization in coronary patient who were effectively treated. POISE study was know by 40% of practitioner, and 18% estimated that they have changed their practice. Preoperatively, 21% organized multidisciplinary approach for high-risk patient. During surgery, 63% monitored the ST-segment. In postoperative period for cardiac-risk patient, only 11% prescribed systematically an ECG, a troponin dosage, a postoperative monitoring of ST-segment, a cardiologic advice. In case of moderate troponin elevation, they were 70% to realize at least an ECG and/or an echocardiography.
  
  
  CONCLUSIONS
  This study highlights some difference between current recommendation concerning assessment of cardiac-risk patient in non-cardiac surgery and daily practice of anesthetist, justifying regular update of this one.
authors.affiliation: Service d'anesthésie réanimation, centre hospitalier Lyon-Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
authors.forename: N
authors.initials: N
authors.lastname: Sens
authors.forename: A
authors.initials: A
authors.lastname: Payan
authors.forename: F
authors.initials: F
authors.lastname: Sztark
authors.forename: V
authors.initials: V
authors.lastname: Piriou
authors.forename: H
authors.initials: H
authors.lastname: Bouaziz
authors.forename: N
authors.initials: N
authors.lastname: Bruder
authors.forename: S
authors.initials: S
authors.lastname: Jaber
authors.forename: L
authors.initials: L
authors.lastname: Jouffroy
authors.forename: G
authors.initials: G
authors.lastname: Lebuffe
authors.forename: J
authors.initials: J
authors.lastname: Mantz
authors.forename: V
authors.initials: V
authors.lastname: Piriou
authors.forename: S
authors.initials: S
authors.lastname: Roche
authors.forename: F
authors.initials: F
authors.lastname: Sztark
authors.forename: F
authors.initials: F
authors.lastname: Tauzin-Fin
mesh_terms: D000328:Adult; D000776:Anesthesiology; D005080:Exercise Test; D005260:Female; D005602:France; D019538:Health Care Surveys; D006331:Heart Diseases / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians; D011182:Postoperative Care; D011247:Pregnancy; D011300:Preoperative Care / Q000706:statistics & numerical data*; D011364:Professional Practice; D012017:Referral and Consultation; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: Cardiac-risk patients; Chirurgie non cardiaque; Non-cardiac surgery; Patient à risque coronarien; Perioperative; Professional practice evaluation; Périopératoire; Évaluation des pratiques professionnelles